title: Procalcitonin ratio as a predictor of successful surgical treatment of severe necrotizing soft tissue infections.
abstract: BACKGROUND
  Necrotizing soft tissue infections often are characterized by fulminant presentation and lethal outcomes. Besides critical care support and antibiotic therapy, aggressive surgical treatment is important for the therapy of necrotizing fasciitis. The aim of this study was to develop a procalcitonin (PCT) ratio indicating successful surgical intervention.
  
  
  METHODS
  The study group consisted of 38 patients treated with clinical signs of sepsis caused by a necrotizing soft tissue infection. All patients received radical surgical treatment, and serum levels of PCT and C-reactive protein were monitored postoperatively. The ratio of day 1 to day 2 was calculated and correlated with the successful elimination of the infectious source and clinical recovery.
  
  
  RESULTS
  An eradication of the infectious focus was successfully performed in 84% of patients, averaging 1.9 operations (range 1 to 6) to achieve an elimination of the infectious source. The PCT ratio was significantly higher in the group of patients with successful surgical intervention (1.665 vs .9, P < .001). A ratio higher than the calculated cutoff of 1.14 indicated successful surgical treatment with a sensitivity of 83.3% and a specificity of 71.4%. The positive predictive value was 75.8%, and the negative predictive value was 80.0%.
  
  
  CONCLUSIONS
  The PCT ratio of postoperative day 1 to day 2 following major surgical procedures for necrotizing soft tissue infections represents a valuable clinical tool indicating successful surgical eradication of the infectious focus.
authors.affiliation: Trauma Center Murnau, Germany. Jan.Friederichs@bgu-murnau.de
authors.forename: Jan
authors.initials: J
authors.lastname: Friederichs
authors.forename: Martin
authors.initials: M
authors.lastname: Hutter
authors.forename: Christian
authors.initials: C
authors.lastname: Hierholzer
authors.forename: Alexander
authors.initials: A
authors.lastname: Novotny
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Volker
authors.initials: V
authors.lastname: Bühren
authors.forename: Sven
authors.initials: S
authors.lastname: Hungerer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016009:Chi-Square Distribution; D019115:Fasciitis, Necrotizing / Q000097:blood* / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D018461:Soft Tissue Infections / Q000097:blood* / Q000382:microbiology / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: Necrotizing fasciitis; Necrotizing soft tissue infection; Procalcitonin